Out-of-Network Benefits

What are Out-of-Network (OON) Benefits?

Out-of-network benefits are sometimes available as part of your health insurance plan. This allows you to work with a provider of your choosing, regardless of whether or not they are in network.

Out-of-Network Benefits: When they Make Sense

When it comes to mental health, you may not want to spend the time researching and trying to locate a provider who is in-network. Perhaps you have a referral to a therapist your friend recommends. If you are looking for specialized care, or are want to choose for yourself who to work with, using out-of-network benefits make sense.

Did you know? 

In many cases, clients who have mental health insurance coverage can receive a reimbursement of up to 60-70% of fees paid?

How do I find out if I have Out-of-Network benefits?

First, contact your insurance administrator. You can visit this website which has links to all the major plans. Ask, “Do I have Out-of-Network benefits in my plan?” Most importantly, you’ll want to find out exactly how this process works.

All insurance companies differ in how they administer the out of network benefits, so it’s important to know exactly how your plan operates.

What’s next?

I have Out-of-Network benefits, now what?  

If you have these benefits, you must pay the full fee at the time of service. The provider will provide you with a detailed receipt, known as a “Super Bill”.

Last steps: You will submit this Super Bill to your insurance company. Then, upon review of the insurance plan, you will receive the allowed reimbursement. You may get back up to 70% of what you paid up front!

What’s the catch?

You are responsible for full payment for each session

It is always the patient/member responsibility to verify coverage, deductibles, and to understand how to submit claims, and if any authorizations are required. Ask questions up front so you know what you must do, and keep careful records along the way.

Sometimes there is a delay between the visit and receiving the reimbursement. Be prepared to cover this cost until you receive your remaining funds.

While this process might sound intimidating, it is your right as a policy holder to choose the mental health provider that best suits you! In the end, out-of-network costs often end up being comparable to the cost of seeing an in-network provider (Copay ranges $25-40).  For sure, it is cheaper than going with a service where you can only pay out of pocket.  

Bottom Line

If your plan covers out-of-network providers, they will work with you to obtain the benefits (money) you have purchased with your health insurance plan. 

It’s your right as a consumer to obtain all the benefits your plan provides for you… after all, you’re already paying for them!

Please reach out to your insurance carrier to find out more about how to make your insurance benefits work for you. Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) are also often accepted by many therapists!

For more information, check out this article from the Patient Advocate Foundation (patientadvocate.org).

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